Derron Ewers v. RBC General Insurance Company, 2007 ONFSCDRS 173

Financial Services Commission of Ontario

Neutral Citation: 2007 ONFSCDRS 173

FSCO A06-000116

BETWEEN:

DERRON EWERS

Applicant

and

RBC GENERAL INSURANCE COMPANY

Insurer

REASONS FOR DECISION

Before: David Muir

Heard: July 3 and 4, 2007, at the offices of the Financial Services Commission of Ontario in Toronto.

Appearances: Amanda Heerschop for Mr. Ewers James Leone for RBC General Insurance Company

Issues:

The Applicant, Derron Ewers, was injured in a motor vehicle accident on December 24, 2004. He applied for and received statutory accident benefits from RBC General Insurance Company (“RBC”), payable under the Schedule.¹ The parties were unable to resolve their disputes through mediation, and Mr. Ewers applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.

Mr. Ewers claims that he was rendered substantially unable to perform his pre-accident housekeeping and home maintenance responsibilities as a result of injuries sustained in the accident. He also seeks a benefit for treatment that he claims was reasonable and necessary to treat injuries sustained in the accident as well as the cost of an assessment.

A special award claim was withdrawn at the outset of the hearing.

Stated formally, the issues in this hearing are:

1. Is Mr. Ewers entitled to be paid a medical benefit for treatments provided by East Sheppard Rehabilitation pursuant to section 14 of the Schedule?

2. Is Mr. Ewers entitled to be paid a benefit for housekeeping and home maintenance pursuant to section 22 of the Schedule?

3. Is Mr. Ewers entitled to be paid a benefit for a follow-up in-home assessment conducted by Phoenix Assessments, pursuant to section 24 of the Schedule?

Result:

1. Mr. Ewers is entitled to a medical benefit for treatment plans dated March 29 and May 14, 2005 in the amounts of $825 and $772 respectively, pursuant to section 14 of the Schedule.

2. Mr. Ewers is entitled to be paid a benefit of $5 per week for housekeeping and home maintenance benefits from April 16 to June 16, 2005 pursuant to section 22 of the Schedule.

3. Mr. Ewers is not entitled to be paid a benefit for assessments pursuant to section 24 of the Schedule.

4. Mr. Ewers is entitled to be paid 50% of his expenses by RBC. RBC will bear its own expenses.

EVIDENCE AND ANALYSIS:

Mr. Ewers lives with his family in a large 5 bedroom suburban home. Mr. Ewers, 24 years of age at the time of the accident, is the eldest of four siblings, all of whom still live in the family home. Mr. Ewers was not employed at the time of the accident.

He sustained Wad II injuries to his neck and back in the December 24^th car accident when he was rear ended by another vehicle while stopped at an intersection. In his evidence, Mr. Ewers described how he lurched forward and back upon impact and struck his forearm or elbow on the gear shift of his vehicle. At the time, he and the other occupants of the vehicle were fine and he returned to his home. The next morning, Christmas Day, he awoke with significant pain across his shoulder, his neck as well as his mid and lower back.

On Boxing Day, he saw a lawyer and filed a claim for accident benefits. On December 28^th he attended at East Sheppard Rehabilitation (the clinic) for treatment

Medical Evidence:

Mr. Ewers was assessed by Dr. Grant Alyea, at the time a chiropractor at the clinic. Dr. Alyea, who gave evidence at the hearing, diagnosed “sprain/strain of the ligaments and joints in the cervical spine with facet irritation (WAD II), thoracic sprain/strain with facet irritation, and lumbar sprain/strain with facet irritation.”

Dr. Alyea recommended a course of treatment within the Pre-approved